EPA’s Health Care Provider Initiative
Kevin Keaney, ChiefPesticide Worker Safety Programs
U. S. EPA2005
EPA’s Health Care Provider Initiative
EPA’s Health Care Provider Initiative
EPA’s Health Care Provider Initiative
EPA’s Health Care Provider Initiative
EPA’s Health Care Provider Initiative
Resources for Pesticide Competency & Practice Skills Government
-- Federal Government Agencies -- State Government Contacts and Resources
Resources and Publications-- Key Resources on the Web -- Handbooks, Databases, and Publications -- Software and Training -- Case Studies -- Journals
Background Papers -- A Pesticide Primer --Pesticide Laws and Regulations Glossary
Environmental History Taking Tool
EPA’s Health Care Provider Initiative2005 - 2010
EPA’s Health Care Provider InitiativePacific Northwest Agricultural Safety & Health Center
(PNASH)Established in 1996
One of nine Agricultural Safety & Health Centers created by NIOSH
Part of the Dept. of Environmental & Occupational Health Sciences at the University of Washington School of Public Health & Community Medicine.
Ranked as fourth best school of public health in the nation.
Goal: Reduce occupational disease and injury among those who work in
agriculture and their families.
Emphasizes partnerships and collaboration with a wide range of stakeholders, from employers to community organizations.
EPA’s Health Care Provider Initiative2005 - 2010
EPA’s Health Care Provider Initiative
Migrant Clinicians Network
A national, not-for-profit organization
Founded in 1984 by clinicians working in migrant health.
Nearly 2,000 members
The oldest and second largest clinical network serving the underserved
Goal:Improve health care of migrants and other mobile poor populations by providing support, technical assistance, and professional development services to clinicians.
Tracking Occupational Tracking Occupational Pesticide Incidents Pesticide Incidents
for Pesticide Worker Safetyfor Pesticide Worker Safety
..
Occupational Pesticide IncidentsOccupational Pesticide Incidents
Incidents: Incidents:
““health” = a well-documented exposure from health” = a well-documented exposure from pesticide use in an occupational context pesticide use in an occupational context resulting in adverse health effects. The resulting in adverse health effects. The source of the data must be credible, accurate source of the data must be credible, accurate and unbiased.and unbiased.
““enforcement” = a well documented regulatory enforcement” = a well documented regulatory agency’s pesticide enforcement action.agency’s pesticide enforcement action.
Problem and IntentProblem and Intent
Problem:Problem: Currently there is no national Currently there is no national program that collects accurate, unbiased program that collects accurate, unbiased pesticide incident data.pesticide incident data.
Statement of Intent:Statement of Intent: Collect, analyze and Collect, analyze and communicate accurate, unbiased communicate accurate, unbiased incident data in order to improve risk incident data in order to improve risk assessment, risk management and field assessment, risk management and field programs that affect occupational programs that affect occupational pesticide workers.pesticide workers.
GoalsGoals
Utilize incident data to:Utilize incident data to:
11. Improve field programs. Improve field programs
2.2. Improve risk assessmentImprove risk assessment
3.3. Improve risk managementImprove risk management
4.4. Enhance communications with Enhance communications with stakeholdersstakeholders
5.5. Evaluate program progressEvaluate program progress
Workers Exposed to Pesticides
Establish & CommunicateSafety Measures
Risk Management
Data Analysis Outcome Measures
Trend AnalysesFeedback to Data Selection
Data SelectionIdentify Evaluate
Select
Pesticide Worker SafetyPesticide Worker Safety
Communicate to the public
Data Selection: Incident Data Selection: Incident DatabasesDatabases
There are a number of databases which There are a number of databases which capture worker incident data. Specific capture worker incident data. Specific criteria will be used to evaluate and make criteria will be used to evaluate and make proposed decisions for our use of these proposed decisions for our use of these data bases.data bases.
Data SelectionData Selection
• Are the data valuable, acceptable, useful, Are the data valuable, acceptable, useful, and meaningful?and meaningful?
• Is the associated burden low – easy to Is the associated burden low – easy to collect, costs are acceptable, small collect, costs are acceptable, small number of measures, and user friendlynumber of measures, and user friendly
• Data that can be used nowData that can be used now
• Data that could be used, if modifiedData that could be used, if modified
Data Selection ListData Selection ListHealth Health
SENSORSENSOR
CA ProgramCA Program
Poison ControlPoison Control
FIFRA 6(a)2FIFRA 6(a)2
NPICNPIC
Worker’s CompWorker’s Comp
WA ChE WA ChE
EnforcementEnforcement
National Pesticide National Pesticide Field Data planField Data plan
Compliance Action Compliance Action Tracking Systems Tracking Systems
Support DataSupport Data
National National Agricultural Agricultural Workers SurveyWorkers Survey
Bureau of Labor Bureau of Labor StatisticsStatistics
Usage DataUsage Data
Cert. Applic. #sCert. Applic. #s
Data Collection Evaluation CriteriaData Collection Evaluation Criteria
ContentContent Occupational extractabilityOccupational extractabilityChemical type - active ingredientChemical type - active ingredientLevel of detail in case description, raw dataLevel of detail in case description, raw dataLink to enforcement - specific violations, investigations, independent Link to enforcement - specific violations, investigations, independent
verificationverificationClassification of probability - causality, confidence in pesticides being causeClassification of probability - causality, confidence in pesticides being causeSeverity index - how serious were symptomsSeverity index - how serious were symptoms
RepresentativeRepresentativeData reliability - collection method; are incidents self-reported or do the data Data reliability - collection method; are incidents self-reported or do the data
originate from health care practitioner; is there follow-up on the casesoriginate from health care practitioner; is there follow-up on the casesBaseline availability - data longevity, depth and breadth of databaseBaseline availability - data longevity, depth and breadth of database
PresentationPresentation Accessibility - can we get the data, is it in a database, are the formats Accessibility - can we get the data, is it in a database, are the formats
consistent, cooperation of ownerconsistent, cooperation of owner
CostCost$, FTE$, FTE
Health Data Selection: EvaluationHealth Data Selection: Evaluation
Data Source
Chemical collected
Occupational exposure
Representative sample for nation
User-friendliness
Classification of probability
Severity index
Link with enforcement
Data reliability
Data accessibility
Level of detail
Baseline available
Cost
Proposed Decision
SENSOR
Y Y Y Y Y Y N H Y M Y M accept
PISP
Y Y N Y Y N Y H Y H Y L accept
PCC/TESS
Y Not well ? ? N Y N L Y M Y M acce
ptFIFRA 6(a)2
Y Notwell N N N Y N L N L Y L impr
oveNPIC
YNot well Y N Y Y N L N L Y H rejec
tWorkers Comp
N Y N N N Y N H N H N H reject
Enforcement DataEnforcement Data•Information on regulatory investigations linked to Information on regulatory investigations linked to specific incidents useful for:specific incidents useful for:
• Determining application specifics and why incident occurred,Determining application specifics and why incident occurred,• If a violation, which part of the regulatory scheme was not If a violation, which part of the regulatory scheme was not
followedfollowed• Tracking incident cause in order to formulate program Tracking incident cause in order to formulate program
improvementsimprovements
•OECA “5700” Forms summarize state inspection totals - OECA “5700” Forms summarize state inspection totals - includes totals by WP rule sectionsincludes totals by WP rule sections
•Most states only report federally funded inspections -Most states only report federally funded inspections -enforcement data is subset of state total enforcement data is subset of state total
National Pesticide Field Data – EnforcementNational Pesticide Field Data – Enforcement
• Database is a collection of closed pesticide Database is a collection of closed pesticide enforcement cases from several states enforcement cases from several states - - Severely limited in content for purposes of Severely limited in content for purposes of incident analysis, exact violation not collected incident analysis, exact violation not collected -- No quality control of the data - no plan for No quality control of the data - no plan for linkslinks
to incident datato incident data
Proposed action: enforcement and state liaisons Proposed action: enforcement and state liaisons should pursue development to improve should pursue development to improve usefulness for measures. In its current state, the usefulness for measures. In its current state, the data are not useful.data are not useful.
Compliance Action Tracking Systems - Compliance Action Tracking Systems - EnforcementEnforcement
• Systems were developed to help state lead agencies Systems were developed to help state lead agencies communicate their enforcement activities. Two communicate their enforcement activities. Two regions and several states outside those regions use regions and several states outside those regions use these tracking systems for their enforcement data.these tracking systems for their enforcement data.
+ Collects enforcement data + Collects enforcement data
- Unclear whether adequate detail is available - Unclear whether adequate detail is available
- Link to incident data seems absent- Link to incident data seems absent
Proposed Action: continue review and work with Proposed Action: continue review and work with enforcement and state liaisons on gathering enforcement and state liaisons on gathering enforcement dataenforcement data
Supporting DataSupporting Data
Information about pesticide use patterns, Information about pesticide use patterns, migrant worker demographics, worker migrant worker demographics, worker attributesattributes
Used to characterize exposed populations and Used to characterize exposed populations and develop incident rate estimates develop incident rate estimates
Important in understanding the context of Important in understanding the context of pesticide and agricultural worker issues.pesticide and agricultural worker issues.
Supporting DataSupporting Data
• National Agricultural Worker SurveyNational Agricultural Worker Survey
• Bureau of Labor StatisticsBureau of Labor Statistics
• Pesticide usage data – amount used on Pesticide usage data – amount used on
crops by state - includes USDA / NASS, crops by state - includes USDA / NASS, Doane, CA pesticide use reportingDoane, CA pesticide use reporting
• Certified applicator numbersCertified applicator numbers
Health Care Provider InitiativeHealth Care Provider Initiative&&
National Incidents ReportNational Incidents Report
ANY QUESTIONS ?ANY QUESTIONS ?